Childhood Obesity in Near Northeast Denver€¦ · Web viewHealth and Social Determinants Related to ... finding that children living in a household with an income of less than $25,000

Running head: CHILDHOOD OBESITY IN NEAR NORTHEAST DENVER 1

Childhood Obesity in Near Northeast Denver

Erin Hoffman, Nicole Bonato, Lindsey Newnes, Yanka Skyton, Stephen Shea, Lauren Delucca

Submitted to Terry Lee, MS, RN, BC in partial fulfillment of

NR 455 Health Promotion, Disease Prevention, and Health Policy

Regis University

July 1, 2014

CHILDHOOD OBESITY IN NEAR NORTHEAST DENVER 2

Childhood Obesity in Near Northeast DenverIntroduction

National rates of childhood obesity have doubled in the past 30 years. As a result,

today’s children are developing diseases and comorbidities that previously were rarely found in

pediatric populations, including fatty liver disease, hypertension, type 2 diabetes and sleep apnea.

Coupled with the long-term psychological and financial effects, childhood obesity is now

considered an epidemic by the Centers for Disease Control and Prevention (CDC, 2014).

Ultimately, all Americans will shoulder the burden of childhood obesity. Colorado has

the second-fastest rising rate of childhood obesity in the nation. Between 2003 and 2007, the

number of obese children in the state jumped from 48,000 to 72,000, with Hispanic boys and

African American girls as the highest risk demographics (CHF, 2010). Evidence suggests a link

between poverty, lack of education, and childhood obesity. In the U.S., the incidence of severe

obesity is 1.7 times greater among poor or impoverished children with 70% of obese adolescents

growing into obese adults (Skelton et al., 2009).

The geographical area of Near Northeast Denver (NNE Denver) includes the

neighborhoods of Five Points, Cole, Whittier, Clayton and Skyland. It is home to nearly 30,000

people with 20% of the total population being children. Of the child population, 56% are

Hispanic and 24% are African American. Additionally, 86% of all children who attend primary

school in NNE Denver qualify for reduced or free lunch programs based on their family’s

average annual household income. Approximately, 40% of all NNE Denver adults have less

than a 12th grade education and make an average salary of $35,000 per year. Therefore, it tracks

that one of the populations at greatest risk for developing obesity are children, aged 6 to 11,

living in NNE Denver (The Piton Foundation, 2012).


The purpose of this paper is to discuss the most common causes of childhood obesity and

identify opportunities for wellness and advocacy programs that specifically benefit school age

children, 6 to 11 years of age, in Near Northeast Denver, Colorado.

Health and Social Determinants Related to Health Issue

Despite Colorado’s reputation as one of the leanest states in the U.S., several health and

social determinants are likely contributing to the state’s rapid rise in childhood obesity.

Common factors associated with childhood obesity present in NNE Denver include poverty, lack

of education, and living in a food desert; meaning limited access to affordable and healthy food

choices.

As previously mentioned, poverty or low socioeconomic status plays an integral part in

determining childhood obesity. Studies have shown low income households have higher rates of

childhood obesity, finding that children living in a household with an income of less than

$25,000 per year are three times more likely to be obese than children with a household income

of more than $75,000 per year (Beck, 2010). Since Colorado defines poverty as households of

four, making less than $24,000 per year, NNE Denver families sit just above this with an annual

household income of $35,000. However, a large percentage (47%) of NNE Denver families

spend one-third of their monthly income on rent, with rental costs continuing to increase (The

Piton Foundation, 2011).

This is significant because food costs are also continuing to climb, eating away at

disposable income. Colorado has seen a 0.2% increase in all food prices this year alone (Schoen,

2014). If the typical family of four spends an average of $200 a week on groceries to prepare

three meals and two snacks per person, each day that consumes 42% of a NNE Denver family’s

household budget (Hellmich, 2013). It is no surprise then that some families opt to spend $1 per


person, per meal on a fast food cheeseburger and opt to skip the expensive, fresh produce despite

the long-term consequences to their health. “Processed food and fast food offer a lot of calories

for the dollar but not a lot of nutrients. That's one reason we have people who are overweight but

undernourished” (Hellmich, 2013).

Even if residents in Near Northeast Denver are aware that fast-food is less nutritious than

a home-prepared meal, they may lack knowledge regarding nutrition and the impact that fast

food presents to their children’s long-term health. For example, fast food is loaded with calories

and sodium. Excess calories and sodium intake can lead to an increase in fat stores or obesity,

hypertension, stroke, heart disease, and kidney disease. Therefore, the FDA recommends no

more than 2,300 mg of sodium per day and no more than 1,500 calories per day for active

children. Yet, the average McDonalds happy meal contains approximately 900 mg of sodium

and 800 calories (Cahana, 2011). While that might not seem like an overly excessive amount of

extra calories or sodium, it adds up when you consider that 25-30% of American children eat fast

food on a daily basis (Cahana, 2011). When parents were asked what made them choose

McDonald’s for lunch, the most common responses were that their “kids like the food” and it is

convenient (Cahana, 2011).

This might lead some to infer that parents today are lazy or disinterested in the health of

their children. However, some families -- like those in Near Northeast Denver -- live in what is

coined a food desert. Food deserts are geographical locations lacking an affordable supply of

healthful food. According to the USDA, food deserts are usually found in impoverished areas

that lack grocery stores, farmers’ markets, and healthy food providers. (American Nutrition

Association, 2011). Children living in NNE Denver have minimal access to supermarkets or


grocery stores and heavily rely on fast food restaurants or convenience stores as sources of food

(Rapone, 2013).

There are currently several organizations, such as The GrowHaus, Denver Healthy

People, and 4-H, with initiatives aimed at improving access and availability to produce for

residents of the NNE Denver area. However, this population is still considered underserved

which undoubtedly contributes to its rising childhood obesity rates.

Major Health Issue for this Population

“The percentage of children aged 6-11 years in the United States who were obese

increased from 7% in 1980 to nearly 18% in 2012” (CDC, 2014). Obesity can best be described

as the excessive accumulation of fat, however body composition in children varies with age and

gender. Therefore, a good way to determine a child’s body fat is to compare their weight and

height in order to calculate body mass index or BMI. A child whose weight falls at or above the

85th percentile on growth charts is likely overweight, at the 95th percentile or above is likely

obese, and at the 97th percentile or above is likely severely obese. The Office of the Surgeon

General explains that obesity is the result of caloric imbalance or deficit. Meaning, that too few

calories are being expended to compensate for the excess intake (U.S. Department of Health and

Human Services, 2010). Therefore, childhood obesity is a key health issue for the population of

NNE Denver due to the serious physical, psychological, and financial ramifications.

Children who are obese have a heightened risk for obesity in adulthood as well as

elevated blood pressure, cholesterol, and diabetes. “In one study, 70% of obese children had at

least one cardiovascular disease risk factor, and 39% had two or more,” raising their risk of

mortality from heart attacks and stroke exponentially (CDC, 2014). Therefore, we’ll likely see a


decrease in life expectancy rates as obese children are diagnosed with chronic and preventable

diseases earlier and earlier in life.

In addition to physical problems, there are also psychological issues related to obesity

such as social stigma, discrimination and low self-esteem (CDC, 2014). In the United States,

obesity carries a negative stereotype and unfortunately the culture of school aged children often

includes bullying and teasing when someone is viewed as different. Therefore, it is no surprise

that when a study asked children to rate their quality of life based on activities such as play,

exercise, and sleep, obese children “rated their quality of life with scores as low as those of

young cancer patients on chemotherapy” (NYU Langone Medical Center, 2014 ).

The Duke Global Health Institute examined the economic impact of obesity and found

that the estimated lifetime medical costs for an obese child is $19,000 more than that of a healthy

weight child. This difference accounts for doctor’s visits and medications but does not include

the added expense of absenteeism or loss of productivity in working adults. The report goes on

to say that if this figure were applied to obese 10 year olds alone, it would total 14 billion dollars

(Duke Global Health Institute, 2014). The significant physical, psychological, and financial

consequences of childhood obesity, has led to it being considered a national epidemic. The

children of NNE Denver are one of countless communities facing the serious consequences of

American eating habits.

Goals and Objectives

A key component to childhood obesity is that it’s completely preventable. Childhood

obesity is related to lifestyle factors that can be modified to improve the lives of all children,

including those living in NNE Denver. One goal for decreasing obesity rates in children of NNE

Denver, is to increase their intake of fresh produce. “Increased consumption of fruits and


vegetables has been recognized as a successful strategy for reducing (childhood) obesity”

(Berlin, et al., 2013).

To accomplish this, other cities have created farm-to-school (F2S) programs. There are

currently 2,000 F2S programs in 9,000 schools nationwide (Berlin, et al., 2013). F2S programs

connect local farmers with schools through field trips and by distributing fresh fruits and

vegetables from the farms to be eaten in the school’s cafeteria. As a result of these programs,

three out of four studies found increases in fruit and vegetable consumption of school-aged

children (Berlin, et al., 2013). Therefore, the creation of a F2S program in NNE Denver primary

schools would likely have a significant impact on local childhood obesity rates.

A second goal for children of NNE Denver, is to increase their knowledge of healthy

snack options. Classroom-based culinary classes that integrate nutrition basics with meal

preparations have shown an increase in produce consumption from 0.2 to 0.99 servings (Berlin,

et al., 2013). It can also increase a child’s interest in trying new foods. Studies have shown a

“significant and lasting increase in knowledge and preferences for vegetables among students

who received nutrition education” (Berlin, et al., 2013). Thus, an increase in knowledge

translates to an increased appetite for fresh produce. Implementing a similar culinary experience

in NNE Denver could set the stage for reducing obesity in its child population.

Though the children of NNE Denver are at high risk for developing obesity, it is possible

to buck the national trend and improve their general health. By taking an active approach to

educating NNE Denver children on healthful foods and improving their access to fresh produce,

it is likely they would modify certain risky behaviors to curb childhood obesity.

Nursing Implications

Thus far, this paper has established that a number of children living in NNE Denver are

food insecure and at risk for obesity. Using Gordon’s Functional Health Patterns, it is evident


that these children are not getting their nutritional-metabolic needs met for a variety of reasons.

Therefore, the nursing diagnosis for the obese children of NNE Denver is altered nutrition, more

than body requirements related to poor dietary habits, excessive caloric intake related to

metabolic needs, and lack of knowledge regarding nutritional needs, food intake, and/or

appropriate food preparation.

Since nursing is the nation’s largest healthcare profession, these men and women are

uniquely situated to address the issue of childhood obesity from a community perspective.

However, before any actions or nursing intervention can be named, nurses need to be cognizant

of and sensitive to the factors that lead to childhood obesity in NNE Denver.

For example, nurses cannot simply recommend that these children increase their intake of

fruits and vegetables, because most of them do not have access to fresh produce or the funds to

purchase it. Recognizing how household budgets, lack of nutritional knowledge, and inadequate

transportation impact childhood obesity rates, will assist nursing professionals in finding

successful solutions to overcome these obstacles and improve the health of children in NNE

Denver.

For example, if these children do not have access to healthful foods or lack basic nutrition

information, then creating a community garden at a local school and supplementing it with

community-wide education sessions would be an appropriate nursing health promotion

intervention. Using the Social Cognitive Theory as a model, families from the community could

get involved in the garden to grow their own produce and learn about food selection, planning,

and preparation.

The social cognitive theory is a model that emphasizes the influence of self-efficacy and

learning through observation to motivate health behavior changes. It is commonly used to aid in


the design of youth-related food and nutrition interventions (Berlin et al., 2013). Growing a

school garden to be utilized by an after-school program where children learn about nutrition and

gardening is a way of encouraging healthy eating while providing appropriate means to do so.

Furthermore, the CDC has found that outdoor, hands-on experiences like school gardening and

classroom-based nutrition education is a successful strategy in reducing obesity and increasing

student’s fruit and vegetable consumption (Berlin et al., 2013).

To address the nutritional-metabolic needs of these children with the guidance of the

social cognitive theory, lessons could focus on nutrition, exercise, personal awareness and

interpersonal skills. Topics such as identifying food groups, vitamins, proper portion size, and

learning to read and understand nutrition labels would address the current knowledge deficit

related to nutritional needs. Exercise would be incorporated through gardening activities and

provide hands-on learning which increases a child’s interest, involvement, and the ability to

retain information (Berlin et al., 2013; deGroot, n.d.). Personal diet assessment and taking small

steps to achieve positive change integrates personal awareness, while interpersonal skills are

developed through group work (Denver Urban Gardens, 2012). This social and observational

component is a key feature to learning and reinforces behavior change in the social cognitive

theory.

The overall objective is to help kids increase their daily intake of fruits and vegetables,

increase their knowledge of nutrition, learn about easy to make healthy snacks, and build

confidence in their ability to influence their own health. The kids can share their knowledge and

excitement of caring for a garden and picking fresh vegetables with the community.

Additionally, school staff and community members become models for healthy behavior that the

children can adopt. Finally, having parents join their kids at school once a month to learn


healthy, tasty recipes while cooking with their child endorses family interest and involvement in

healthy habits. The net result may not end childhood obesity in NNE Denver, but it could reduce

the overall incidence and establish lifelong healthy habits.

Wellness Advocacy

Since health care providers are in a unique position to promote wellness and healthy

lifestyles through advocacy, they are often on the frontlines of community health. Nurses can

generally spot trends and be the first to notice evidence of health problems within a community.

For example, a health care provider noticing a pattern of overweight first graders may focus on

assessment of nutritional knowledge, availability of and access to healthy food, as well as

parental education about daily nutritional requirements. Additionally, the provider may

approach local schools about conducting an assembly on wellness and nutrition or advocate for

changes to school policy such as replacing soda in school vending machines with bottled water.

Regardless of the issue, the opportunity for advocacy is present at all levels. Healthcare

professionals can play a vital role in the development, review, implementation and management

of health policy through involvement in nonprofits, research associations and professional

organizations focused on reducing obesity rates. They can work with local, state, and federal

governments to create programs and policies related to nutrition within schools and

communities. Through direct involvement in health promotion efforts, health care providers

encourage the community to take steps in reducing and preventing the development of childhood

obesity. They also have the ability to engage families with parental obesity in prevention

activities, supporting parenting styles that increase physical activity while reducing sedentary

behaviors, and encouraging parental modeling of healthy dietary choices.


Evaluation

Project evaluation planning for a community garden should occur at the same time as the

program planning phase. This way, qualitative and quantitative data can be gathered from the

start of the project to the completion of a single school year. Furthermore, if the program is a

success, it may lead to a longitudinal study demonstrating how lifestyle factors, physical health

and nutrition behaviors change over time, year after year

To ascertain information about the community garden’s effectiveness, baseline

information must be gathered before the project begins in order to compare it to the conclusion

of the school year. Quantitative data sets should include the weight, body mass index, academic

scores and amount of produced consumed weekly by the children of NNE Denver. Qualitative

data sets should include all stakeholder feedback gathered by surveys, focus groups and

interviews utilizing open ended questions. By carefully collecting and analyzing both qualitative

and quantitative data, the effectiveness of the community garden initiative could be accurately

assessed and any reduction in childhood obesity detected. This data could then be reviewed to

discover areas in need of improvement and to approach community leaders in order to secure

additional funding for expansion of the program.

Conclusion

With childhood obesity rates continuing to climb, the Center for Disease Control and

Prevention has declared it a national epidemic. Colorado is especially at-risk because the state

has recently seen the second-fastest increasing rate of childhood obesity in the nation. Therefore,

populations in the Near Northeast Denver area are at an increased risk for developing childhood

obesity because they lack adequate funds to purchase fresh produce, do not have proper


education regarding nutrition, and live in a geographical area where fresh fruits and vegetables

are scarce.

Therefore, it is vitally important that families in NNE Denver take action at a local level

to reverse this trend. Solutions to this crisis do not require a large sum of money or need to be

overly complicated. However, they do need the community to buy-in and a local leader step-up

to initiate a plan of action. Something as simple as a community garden would provide at-risk

children, living in a food desert, with access to fresh produce. While tending to the crops, they

can learn about nutrition and how to select ripe produce. Cooking and nutrition classes, using

the bounty of the garden, will provide an additional opportunity for families to learn and spend

quality time together.

In conclusion, childhood obesity is an epidemic that poses serious physical,

psychological and financial risks due to lack of income, access, and knowledge about healthy

eating. However childhood obesity is a preventable disease and solutions exist such as a

community garden.


References

American Nutrition Association. (2011). USDA defines food deserts. Nutrition Digest, 36(4).Retrieved from http://americannutritionassociation.org/newsletter/usda-defines-food deserts

Beck, Christina (2010, July). The Colorado Health Foundation Report: Food Access in Colorado. Retrieved from http://www.coloradohealth.org/studies.aspx

Berlin, L., Norris, K., Kolodinsky, J., & Nelson, A. (2013). The role of social cognitive theory in farm-to-school related activities: Implications for child nutrition. Journal of

School Health 85(8), 589-595.

Cahana, A., (2011, Oct. 12). Study Shows What Kids Eat at McDonalds. Dr. Ayalas Blog. Retrieved

from http://herbalwater.typepad.com/ayalas_herbal_water/2011/10/study-shows-what-kids-eat-at-mcdonalds.html

Centers for Disease Control and Prevention. (2014, March 28). Obesity and overweight: Childhood obesity facts. Retrieved from http://www.cdc.gov/obesity/data/childhood.html

deGroot, K. (n.d.). Plant a snackable vegetable garden: Fun for the whole family! Retrieved from http://www.kidsgardening.org/activity/plant-snackable-vegetable-garden-fun-hole-family

Denver Urban Gardens (2012, November). School garden and nutrition curriculum. Retrieved from http://dug.org/school-garden-curriculum/curriculum-overview/curriculum-

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Duke Global Health Institute. (2014, April 7). Over a Lifetime, Childhood Obesity Costs$19,000 Per Child. Retrieved from

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Feeding America (2014). Map the meal gap. Retrieved from http://feedingamerica.org/hunger- in-america/hunger-studies/map-the-meal-gap.aspx

Friendship Gardens (n.d.). The mission, history & vision. Retrieved from http://www.friendship-gardens.org/

Hellmich, N., (2013, May 1). Cost of feeding a family of four: $146 to $289 a week. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2013/05/01/grocery-costs-for-family/2104165/


NYU Langone Medical Center. (2014) Obesity: The Effects on Physical and Mental Health. Retrieved from http://www.aboutourkids.org/articles/childhood_obesity_effects_physical_mental_health

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Rapone, K. (2013, Jan 30). Quenching Denver’s Food Deserts. Confluence Denver. Retrieved from http://www.confluence-denver.com/features/fooddeserts.aspx

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Childhood Obesity in Near Northeast Denver€¦ · Web viewHealth and Social Determinants Related to ... finding that children living in a household with an income of less than $25,000